Efecto de los tratamientos antirretrovirales en las manifestaciones orales de los pacientes VIH+ / Effects of antiretoviral treatments on oral manifestations in HIV+ patients

El presente trabajo es un estudio para valorar el efecto de los tratamientos antirretrovirales en pacientes seropositivos al VIH, visitados en el dispensario de enfermedades infecciosas del Hospital Vall D´Hebron de Barcelona. Se visitaron 90 pacientes, 51 varones (56,7%) y 39 mujeres (43,3%), siendo la edad media de los pacientes de 36,2 años con una desviación de ±17,8 años y una moda de 35 años. Las visitas fueron realizadas desde enero a diciembre del año 1999. Estos pacientes recibían tratamiento antirretroviral de uno o más fármacos y algunos de ellos (32,2% ) estaban sometidos a tratamiento antirretroviral de alta actividad (TAAA). Asimismo, en estos pacientes se valoró el recuento de CD4 y carga viral de forma bimodal, al inicio del proceso y en el momento de la visita. La exploración de la cavidad oral se realizó en este momento, buscando las lesiones asociadas al Sida según la clasificación de Pindborg y cols., de 1989. La patología más prevalente encontrada en este estudio fue la sensación de boca seca o xerostomía en un 47,8%, seguida por orden de frecuencia de policaries (34,4%) y candidiasis eritematosa (31,1%). Otras manifestaciones orales son muy poco frecuentes, en comparación con los resultados de otros autores en la etapa previa a la utilización de los inhibidores de la proteasa (IP). Así, por ejemplo, se observó un solo caso de leucoplasia vellosa, tan característica antes del año 1996 (AU)

We evaluate the effects of antiretroviral treatments in HIV seropositive patients, who were seen in the Clinic for Infectious Diseases in the Vall D´Hebron Hospital, Barcelona. 90 patients were seen, 51 males (56.7%) and 39 females (43.3%), the mean age of the patients was 36.2 years with a deviation of ±17.8, and a mode of 35 years. The visits were carried out between January and December 1999. These patients were receiving antiretroviral treatment with one or more drugs and some of them (32.2%) were subjected to high activity antiretroviral treatment (HAART). Also, in these patients the CD4 count and bimodal viral load was measured, at the start of the disease process and at the time of visit. Theoral cavity was examined at this time, in search of lesions associated with AIDS according to the classification by Pindborg et al, 1989. The most prevalent pathology found in this study was the sensation of dry mouth or xerostomia in 47.8%, followed by, in order of frequency, multiple caries (34.4%) and erythematous candidiasis (31.1%). Other oral manifestations are very rare, in comparison with the results of other authors in the time before the use of protease inhibitors (PI). There is, for example, only one case of leukoplakia, so characteristic before 1996 (AU)

Diagnosis of mycobacterial infection in acquired immunodeficiency syndrome (AIDS) patients and HIV carriers.

Differences in tuberculosis diagnosis between infected and non-infected HIV patients were described. In Barcelona, tuberculosis is present in 41.6% of 851 patients in whom AIDS was detected between 1981 and the first quarter of 1990. We reviewed the results of the methods used for tuberculosis diagnosis in 270 AIDS patients controlled in our hospital, in whom tuberculosis was detected (33.3%), and we compared these data with the results obtained in HIV carriers with tuberculosis and with tuberculous patients without HIV infection. Statistically significant differences were found between the three groups with respect to sex, age, results of Ziehl-Neelsen stain in pulmonary specimens and skin test reaction; between AIDS patients and the non-HIV infected population differences were observed in tuberculosis site. Positive skin test reaction diminished from tuberculous individuals non-HIV infected (95%), to HIV carriers with tuberculosis (71.8%) and AIDS patients with tuberculosis (21.8%). Acid-fast smears from pulmonary specimens were positive in 35.7%, 23.5% and 43.7% respectively. Statistically significant differences were found in tuberculosis localization between tuberculous patients non-HIV infected and tuberculous patients with AIDS, in the last group tuberculosis lymphadenitis was the most frequent localization (33.3%) of extrapulmonary tuberculosis, followed by abdominal tuberculosis (15.5%). The incidence of HIV infection among tuberculous patients was 4.6 in our study, but could be higher if patients between 19 and 30 years old were always checked for anti-HIV antibodies.

[16 cases of infection by Cryptococcosis neoformans in patients with AIDS]. / Estudio de 16 casos de infección por Cryptococcus neoformans en pacientes con SIDA.

Sixteen patients with AIDS (6% of the total AIDS patients) who had infection by Cryptococcus neoformans were studied. Most of these patients (94%) had cryptococcal meningitis. Only 50% of the cases showed clinical manifestations of neurological involvement. Blood cultures and antigen level measurement were the diagnostic techniques with best results due to their high percentage of positivity. Sixty nine percent of patients survived the acute phase of the infection and only 3 of those who died in this period showed evidence of active infection patients by the fungus.